| NPI | 1356369169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: KY 7229) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 7229) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: KY 7229) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 7229) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2014-06-18 |